Letter to the Editor Regarding “Online Neuroanatomy Education and Its Role During the Coronavirus Disease 2019 (COVID-19) Lockdown”

Letter:

It was our pleasure to read the article by Hall and Border,¹ who implemented online neuroanatomy education during the Coronavirus Disease 2019 (COVID-19) pandemic. We believe that the authors' initiative is important because the pandemic has caused forced restriction of face-to-face learning and has led neuroanatomy teachers to develop alternative educational methods. We would like to comment on the authors' suggestion of online neuroanatomy teaching modules including social media, videos, gamification, and case-based learning. To the best of our knowledge, although online modalities are the principal form of teaching in the COVID-19 era, the literature has not provided evidence that the aforementioned forms of online neuroanatomy education are effective in terms of enhancing knowledge.

We believe that Hall and Border¹ made interesting suggestions when they proposed game-based and case-based neuroanatomy learning. However, to the best of our knowledge, there is lack of evidence to prove that these methods are effective neuroanatomy teaching tools and they have not been adequately investigated, in either the online or face-to-face module. Also, we found interesting the authors' action to develop a YouTube channel and teach neuroanatomy via videos. Although YouTube videos have been used for anatomy education purposes,² we believe that there are no data to support that those videos lead to acquisition of neuroanatomic knowledge. However, given that the COVID-19 pandemic has caused forced restriction of face-to-face teaching, we consider that Hall and Border's¹ initiative could stimulate further research concerning the implementation of online neuroanatomy education methods. Under these circumstances, we believe that online neuroanatomy teaching could be proven to be potentially effective if it provides 3-dimensional (3D) visualization, especially because of the spatial complexity of neuroanatomic structures.

Allen et al³ developed an online 3D interactive neuroanatomy module and included in their study participants who were randomly divided in 2 groups. The first was taught neuroanatomy via the 3D e-learning module, while the second learned via cadaveric gross anatomy resources. The 2 groups did not differ significantly in terms of baseline anatomy knowledge. However, after the educational intervention, it was found that the online 3D module led to significantly higher acquisition of knowledge in comparison with the cadaveric gross anatomy resources. The authors concluded that incorporation of 3D online learning resources can improve students' anatomic knowledge, particularly concerning spatially complex neuroanatomic structures, which are difficult to be accessed during cadaveric dissection.

The participants studied by Shao et al⁴ were randomly allocated to 2 groups and taught neurosurgery of skull base tumors and basic theory of skull base structure. The first group was taught via text, images, animation, and video in the form of multimedia data sets, problem-based and case-based learning. The second group was taught via a digital 3D module (virtual reality). The authors demonstrated that the second group performed significantly better than the first group and underlined the value of 3D visualization of neuroanatomic structures.

In conclusion, we believe that, in the era of the COVID-19 pandemic, the structure of an online neuroanatomy curriculum does play a role in its effectiveness. It seems that 3D visualization that can be offered by digital modalities can essentially enhance neuroanatomic knowledge. Thus online modules including social media, game-based, and case-based neuroanatomy learning seem to be inadequate to lead to acquisition of sound neuroanatomic knowledge if they are not accompanied by 3D visualization.